Provider Demographics
NPI:1568570497
Name:JOSE, BABY OLIAPURAM (MD)
Entity Type:Individual
Prefix:
First Name:BABY
Middle Name:OLIAPURAM
Last Name:JOSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT 5081 PO BOX 740041
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-7441
Mailing Address - Country:US
Mailing Address - Phone:502-561-2700
Mailing Address - Fax:502-561-2709
Practice Address - Street 1:529 SOUTH JACKSON STREET
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-562-4360
Practice Address - Fax:502-562-4364
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY202832085R0001X
IN01033494A2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64202831Medicaid
C66219Medicare UPIN
IN125310BMedicare ID - Type Unspecified
KY0226902Medicare ID - Type Unspecified